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The objective of this study was to investigate a profile of cardiovascular disease (CVD) risk factors by sex among individuals with and without osteoarthritis (OA) and to consider single‐site and multisite joint OA. Data were sourced from Cycle 1, Comprehensive Cohort, Canadian Longitudinal Study on Aging, a national sample of individuals ages 45 to 85 years. Systemic inflammatory/metabolic CVD risk factors collected were high‐sensitivity C‐reactive protein (hsCRP) level, high‐density lipoprotein, triglycerides, total cholesterol, body mass index (BMI), systolic blood pressure, and hemoglobin A1c. Smoking history was also collected. Respondents indicated doctor‐diagnosed OA in the knees, hips, and/or hands and were characterized as yes/no OA and single site/multisite OA. Individuals with OA were age‐ and sex‐matched to non‐OA controls. Covariates were age, sex, education, income, physical activity, timed up and go test findings, and comorbidities. A latent CVD risk variable was derived in women and men; standardized scores were categorized as follows: lowest, mid‐low, mid‐high, and highest risk. Associations with OA were quantified using ordinal logistic regressions. A total of 6,098 respondents (3,049 with OA) had a median age of 63 years, and 55.8% were women. One‐third of OA respondents were in the highest risk category versus one‐fifth of non‐OA respondents. Apart from BMI (the largest contributor in both sexes), hsCRP level (an inflammation marker) was predominant in women, and metabolic factors and smoking were predominant in men. Overall, OA was associated with worse CVD risk quartiles compared with non‐OA. OA was increasingly associated with worse CVD risk quartiles with increasing risk thresholds among women with multisite OA, but not men. Findings suggest unique CVD risks by sex/multisite subgroups and point to a potentially important role for inflammation in OA over and above traditional CVD risk factors.

Objective.To examine the magnitude and costs of ambulatory primary care, specialist physician care, and hospital service use for musculoskeletal disorders (MSDs) in Canada’s largest province, Ontario.Methods.Administrative health databases were analyzed for fiscal year 2013–2014 for adults aged ≥ 18 years, including data on physician services, emergency department (ED) visits, and hospitalizations. International Classification of Diseases diagnostic codes were used to identify MSD services. A validated algorithm was used to estimate direct medical costs. Person-visit rates and numbers of persons and visits were tabulated by care setting, age, sex, and physician specialty. Data were examined for all MSDs combined, as well as for specific diagnostic groupings.Results.Overall, 3.1 million adult Ontarians (28.5%) made over 8 million outpatient physician visits associated with MSDs. These included 5.6 million primary care visits. MSDs accounted for 560,000 (12.3%) of all adult ED visits. Total costs for MSD-related care were $1.6 billion, with 12.6% of costs attributed to primary care, 9.2% to specialist care, 8.6% to ED care, 8.5% to day surgery, and 61.2% associated with inpatient hospitalizations. Costs due to arthritis accounted for 40% of total MSD care costs ($639 million). MSD-related imaging costs were $169 million, yielding a total cost estimate of $1.8 billion for MSDs overall.Conclusion.MSDs place a significant and costly burden on the healthcare system. Health system planning needs to consider the large and escalating demand for care to reduce both the individual and population burden.

The focus on disability in osteoarthritis (OA) has largely been on the ability to perform specific activities, which neglects the greater implications for social participation. We investigated the association between OA and social participation, considering activity limitations and instrumental supports as intervening variables in the association. Data were from 21,214 respondents, ages 45–85 years, from cycle 1 of the Canadian Longitudinal Study on Aging. The questionnaire elicited information regarding self‐reported doctor‐diagnosed OA, difficulty with 14 activities, perceived availability and receipt of instrumental supports, and 17 social participation activities. Structural equation modeling was used. The primary outcome was social participation, and the primary predictor was OA. The intervening variables included activity limitations, received instrumental supports, and perceived instrumental supports. Latent variables were developed for intervening and social participation variables. The covariates included age, sex, body mass index, income, education, smoking, and comorbidity count. The mean age of the respondents was 63 years, 51% were female, and 26.5% reported having OA. Two distinct social participation indicators were identified, including social participation–diversity and social participation–intensity. When intervening variables were not considered, minimal/no association was found between OA and social participation. When intervening variables were considered, unique pathways linking OA and social participation were found. The overall negative association between activity limitations and social participation was partially direct and partially buffered by both receipt of and perceived availability of instrumental supports. In the absence of activity limitations, OA was associated with greater social participation. Enhanced social participation in people with OA who do not have activity limitations may reflect proactive steps taken by those with mild OA to maintain activity and social engagement. For those with activity limitations, findings highlight the need for interventions to mitigate limitations and draw particular attention to the importance of both provision and awareness of available instrumental supports in maintaining social participation.

To identify and describe back pain trajectory groups and to compare indicators of health status, medication, and health care use in these groups. A representative sample (n = 12,782) of the Canadian population was followed‐up from 1994/1995 to 2010/2011. Participants were interviewed biannually and provided data on sociodemographic (e.g., education) and behavior‐related (e.g., physical activity) factors, depression, comorbidities, pain, disability, medication use (e.g., opioids), and health care use (e.g., primary care visits). We used group‐based trajectory analysis to categorize participants according to patterns in the course of their back pain during the 16‐year follow‐up period and compared indicators of pain, disability, medication, and health care use in the trajectory groups. A total of 45.6% of the participants reported back pain at least once during follow‐up. Of those, we identified 4 trajectories: persistent (18.0%), developing (28.1%), recovery (20.5%), and occasional (33.4%). The persistent and developing groups were characterized as having pain that prevented activities, disability, depression, and comorbidities. There were significant differences in the patterns of medication and health care use across the groups, with a general trend of most to least health care and medication use in the persistent, developing, recovering, and occasional groups. Those in the recovery group had an increasing trajectory reflecting opioid and antidepressant use. Approximately 1 in 5 people with back pain experience a persistent pain trajectory with an associated increase in pain, disability, and health care use. Further research is needed to determine whether the groups identified represent different diagnoses, which may provide insight into the selection of stratified treatment and aid in designing early prevention and management strategies in the population.

Musculoskeletal disorders (MSDs) are a leading cause of healthy years lost due to premature mortality and disability. Our objective was to investigate whether MSDs were commensurably represented within the published health literature. MEDLINEbibliometric data were retrieved for 2011 and 2016. The 25 disease branches, including MSDs, were ranked according to published article counts, proportion of all publications, and increase in publications from 2011 to 2016. Rankings were also considered within 5 groupings of general health journals: geriatrics and gerontology, general and internal medicine, multidisciplinary sciences, primary health care, and public health. There were 532,283 MEDLINEpublications in 2016, a 16% increase over 2011. In 2016, MSDs ranked 13th in publication count, unchanged from 2011. The increase of 11% in MSDpublications from 2011 was below the overall increase. Of 2016 publications, only 7% were MSDindexed, dropping from 7.3% in 2011. MSD‐indexed publications had their highest ranking (8th) within geriatrics and gerontology, and lowest (19th) within public health. MSDs appear underrepresented in the published health literature generally, and specifically within public health, despite their significant population impact. A broader focus on noncommunicable diseases associated with mortality omits noncommunicable diseases such as MSDs that are leading contributors to high morbidity and high costs, and such omission likely contributes to the neglect of recognizing MSDs as a health priority.

To investigate cohort effects in arthritis prevalence across 4 birth cohorts: World War II(born 1935–1944), older and younger baby boomers (born 1945–1954 and 1955–1964, respectively), and Generation X (born 1965–1974), and to determine whether birth cohort effects in arthritis prevalence were associated with differences in risk factors over time or period effects. Analysis of biannually collected data from the longitudinal Canadian National Population Health Survey, 1994–2011 (n = 8,817 at baseline). Data included self‐reported arthritis diagnosed by a health professional, risk factors (years of education, household income, smoking, physical activity, sedentary behavior, body mass index [BMI]), and survey year as an indicator of period. We used hierarchical age–period–cohort analyses to compare the age trajectory of arthritis by birth cohort and to examine the contribution of changes in risk factors and period to cohort differences. More recent cohorts had successively a greater prevalence of arthritis. Risk factors were significantly associated with arthritis prevalence independently of cohort differences. The effects of increasing education and income over time on potentially reducing the arthritis prevalence were almost counter‐balanced by effects of increasing BMI. Significant cohort–BMIand age–BMIinteractions indicated an earlier age of arthritis onset for obese individuals than those of normal weight. Projections that only take into account the changing age structure of the population may underestimate future trends. Our understanding of the impact of BMIon arthritis is likely an underestimate. Cohort differences focus attention on the need to target arthritis management education to young and middle‐aged adults.

ObjectiveTo examine patterns of ambulatory care and hospital utilization for people with musculoskeletal disorders MSDs, including arthritis and related conditions, bone and spinal conditions, trauma and related conditions, and unspecified MSDs.MethodsAdministrative data from the Ontario Health Insurance Plan database for ambulatory care physician visits, the National Ambulatory Care Reporting System database for day outpatient surgeries and emergency department visits, and the Discharge Abstract Database for hospital discharges were used to examine health care utilization for MSDs in fiscal year 2006–2007. Person visit rates number of people with physician visits or hospital encounters per population were calculated.ResultsOverall, 22.3 of Ontarios population 2.8 million persons saw a physician for an MSD in ambulatory settings. Person visit rates were highest for arthritis and related conditions 107.7 per 1,000 population, followed by trauma and related conditions 89.6 per 1,000 population, unspecified MSDs 71.0 per 1,000 population, and bone and spinal conditions 62.4 per 1,000 population. The majority of visits were to primary care physicians, with 83.2 of those with visits for all MSDs seeing a primary care physician at least once. Overall, 33.0 of people with a physician visit for an MSD saw a specialist, with orthopedic surgeons being the most commonly consulted type of specialist. In hospital settings, person visit rates for MSDs were highest in the emergency department, followed by day surgeries and inpatient hospitalizations.ConclusionThe findings of our study highlight the magnitude of health care utilization for MSDs and the central role of primary care physicians in the management of these conditions.

There are suggestions that the relationship between inflammation and pain in osteoarthritis (OA) may differ by sex, yet studies have been limited. We investigated whether the relationship between knee-specific OA pain and systemic inflammatory markers differs by sex.